NUR 668 FINAL QUESTIONS AND ANSWERS
An 8-year-old boy diagnosed with leukemia is referred to child psychiatry because he is
consistently displaying a flat affect, irritability, angry acting out, and occasional physical
aggression toward his 6-year-old brother. What approach should the PMHNP take when
interviewing this child? - Answers -Provide toys and allow the child to play
Which eating disorder is considered ego syntonic? - Answers -Anorexia Nervosa
(Anorexia Nervosa is challenging to treat because it is ego syntonic. In other words,
one's behaviors, feelings and values are in line with the needs of the ego and reliable to
one's self image.)
A 30-year-old G1P0,1 has become increasingly oddly related, neglecting self-care,
sleeping much of the day, eating minimally, crying easily, and despite reassurance that
her pregnancy is progressing normally, worries that she will lose the pregnancy. Which
of the following medications is considered least harmful in pregnancy? - Answers -
Sertraline
A 10-year-old boy who had been prescribed fluoxetine for major depressive disorder
presents to the psychiatric emergency department for running into the street in front of a
car on the way home from school. In the emergency department, he has been
selectively mute, but the nurse practitioner student was able to elicit his desire to be
dead. He has been medically cleared pending a psychiatric evaluation. What is the most
common sign of major depressive disorder in children? - Answers -Psychomotor
agitation
A 6-year-old boy is referred by the child study team for speech difficulty. On
examination the boy is friendly and cooperative, his speech is clear, and he uses simple
sentences with a limited vocabulary. Most notably he confuses verb tenses consistently.
The parents report he met most of his developmental milestones except speech, which
was delayed. His clinical presentation is most consistent with which of the following? -
Answers -Expressive language disorder
The school psychologist refers a 7-year-old girl with difficulty reading, distractibility, and
writing avoidance behaviors. The child has no diagnosed conditions, takes no
medications, and met all of her developmental milestones. She loves arts and crafts and
physical education. Prior to diagnosing a learning disorder, which of the following
screening tests must be performed? - Answers -Vision and hearing
Which disorder is associated with higher rates of ADHD, enlarges testes, a long narrow
face, hypotonia and short stature? - Answers -Fragile X (Fragile X is associated with a
higher rate of ADHD, impaired intellectual ability, learning d/o's, autism spectrum d/o.
Physical attributes include hypotonia, flat feet, enlarges testes, long narrow face, flexible
fingers and short stature.)
,A 10-year-old girl is referred for evaluation of behavioral difficulties. Her teachers report
that she is easily distracted and fails to complete any class work, and often stares off
into space or tries to chat with her neighbor. Her mother reports that mornings are the
most difficult because of her general disorganization and forgetfulness. Otherwise she is
socially engaged and enjoys many activities. Which of the following is the most likely
diagnosis? - Answers -Attention deficit disorder
An 8-year-old boy presents with nocturnal enuresis, which persists despite behavioral
interventions including eliminating fluid intake in the evening, scheduled awakening at
night to use the bathroom, and a urine alarm. Which of the following medications is
most appropriate? - Answers -Imipramine
Sam is 11 years old without past psychiatric history. He was born by normal
spontaneous vaginal delivery with normal APGAR scores. He has met all of his
developmental milestones. He began sixth grade this year and has had increased
trouble falling asleep. He has always had bedtime rituals but lately they are extending in
complexity and length. Most of his time in the evening is spent checking that the lights
are turned off and that the windows are locked. As a result, he is only getting 5 hours of
sleep at night and now has excessive daytime sleepiness with decreased interest in
socialization and failing grades. Which of the following infectious diseases may
contribute to this clinical presentation? - Answers -Streptococcus
The PMHNP is providing psychoeducation and anticipatory guidance to the concerned
parent regarding night terrors. At which stage of sleep is this most likely to occur? -
Answers -Stage 3 to 4
Early onset Schizophrenia is considered what? - Answers -All of the statements listed
are true. (Early onset schizophrenia is rare. It is 8X more prevalent amongst 1st degree
relatives (Sadock, Sadock & Ruiz, 2014).
Child protective services is requested for an evaluation of a 9-month-old girl in foster
care whose mother was on a methadone maintenance program and using cocaine while
pregnant. The child is HIV negative and during the assessment you learn of a 3-year-old
brother who is HIV positive. You are asked to recommend placement for both these
children. Which of the following is best? - Answers -A foster home
A 6-year-old boy is referred by the child study team for speech difficulty. On
examination the boy is friendly and cooperative, his speech is clear, and he uses simple
sentences with a limited vocabulary. Most notably he confuses verb tenses consistently.
The parents report he met most of his developmental milestones except speech, which
was delayed. His clinical presentation is most consistent with which of the following? -
Answers -Expressive language disorder
In regards to Insecure Attachment: Ambivalent type children are more likely to
________________. - Answers -Be bullied (Insecure attachment: Ambivalent children
are uncertain of a caregiver's response regardless of a situation. These children are
,more likely to be bullied and do worse with separations. The caregiver sometimes uses
threats of abandonment as a form of punishment.)
An 8-year-old boy is referred to you for evaluation for disruptive behavior in school. The
teachers report that without warning the boy will make disruptive sounds or shout out in
class. Other than these instances the boy is described as polite and well kempt, but
restless. This clinical presentation is most consistent with which of the following
disorders? - Answers -Tourette's syndrome
Ella is trying to help her 3-year-old son sleep through the night but reports recently he
has had three episodes of waking up within 3 hours of falling asleep with inconsolable
screaming and crying. He then falls back asleep on his own and has no memory of what
happened. What would be the best intervention? - Answers -Create and maintain
bedtime routine and reduce stimuli
A pregnant woman with depression is reluctant to take medication for fear of causing
her baby neonatal abstinence syndrome due to selective serotonin reuptake inhibitor
(SSRI) medication. Her husband states they would like to use a faith healer instead.
Which of the following is most accurate regarding the prognosis of depression during
pregnancy? - Answers -The actual course of depression cannot be predicted
Which of the following statements regarding intellectual developmental disorder is
false? - Answers -IQ test scores remain the gold standard for determining intellectual
disability (IQ test scores are not the gold standard for determining intellectual disability.
Furthermore, IQ tests fail to asses reasoning in real life scenarios and fail to measure
mastery of practical tasks despite measuring conceptual capacity.)
A father brings his 6-year-old son to you because he is worried about him. He states
that the son sits up in bed shortly after falling asleep and screams. He says he is
inconsolable and unable to be awakened during these episodes but eventually he falls
back asleep. The father states he is not able to fall back asleep after those episodes
and is exhausted and falling asleep at work during the day. The child is energetic and
playful during the day and has no memory of the episodes. What is the most
appropriate response? - Answers -"I can see this is upsetting for you."
The certified nurse midwife is evaluating a 29-year-old woman 2 weeks postpartum and
finds her neglecting her self-care and minimally attentive to the baby and will not allow
anyone else to care for the baby. During the visit a PMHNP is able to provide webcam
consultation and liaison services. Based on the information provided, what is the priority
in the management of this patient? - Answers -Admit the patient to the hospital
Which of the following is a potential risk factor for Anorexia Nervosa? - Answers -All of
the statements listed are potential risk factors. (A gay male orientation, Ballet school, &
a male on a high school wrestling team
, A mother 4 months postpartum is referred to infant psychiatry as the baby has failed to
gain weight over the last 2 months. He has dropped from the 75th percentile to the 50th
percentile. The mother states that up until 8 weeks of age he was gaining weight and
growing just fine. The baby is generally happy and continues to meet his developmental
milestones. Of note, the mother has returned to work after her postpartum leave 2
months ago and the baby is in daycare 5 days a week. The mother notes that he has
been increasingly spitting up for the last month soon after receiving breast milk via the
bottle. She has also started to supplement with formula out of concern for his poor
weight gain. This clinical description is most consistent with which type of disorder? -
Answers -Rumination disorder
Which of the following statements regarding intellectual developmental disorder is
false? - Answers -Mild - moderate intellectual disability may not be apparent until
adulthood (Moderate intellectual disability may not be apparent until adulthood is false.
Academic learning difficulty would be apparent in school age children with a mild level
of disability and markedly apparent in those with moderate disability.)
In terms of the management of Bipolar disorder in pregnancy, one should avoid Lithium,
Valproic acid and Carbamazepine, especially in which trimester? - Answers -First
(Lithium, Valproic acid and Carbamazepine have been associated with fetal harm, with
the greatest risk occurring in the first trimester)
An 8-year-old boy diagnosed with leukemia is referred to child psychiatry because he is
consistently displaying a flat affect, irritability, angry acting out, and occasional physical
aggression toward his 6-year-old brother. What approach should the PMHNP take when
interviewing this child? - Answers -Provide toys and allow the child to play
A pregnant woman with depression is reluctant to take medication for fear of causing
her baby neonatal abstinence syndrome due to selective serotonin reuptake inhibitor
(SSRI) medication. Her husband states they would like to use a faith healer instead.
Which of the following is most accurate regarding the prognosis of depression during
pregnancy? - Answers -The actual course of depression cannot be predicted
A 32-year-old woman who is 6-months postpartum requests a psychiatric house call
while her husband is at work. Upon entering the home, the PMHNP notices a well-cared
for infant playing in a crib, and the patient sitting in her breakfast nook overlooking the
nearby park. She is requesting a medication to help her relax because she feels as if
she is walking on eggshells around her husband for fear of him "getting physical with
me" if the baby cries too much. Which of the following best describes this woman's
circumstance? - Answers -Tension building phase
Which of the following statements regarding Autism Spectrum Disorder is false? -
Answers -Asperger's disorder is a separate diagnosis from Autsim Spectrum Disorder in
the DSM-5. (Autism spectrum disorder encompasses the disorder previously referred to
as Asperger's disorder. Previously, Asperger's disorder was used to describe symptoms
An 8-year-old boy diagnosed with leukemia is referred to child psychiatry because he is
consistently displaying a flat affect, irritability, angry acting out, and occasional physical
aggression toward his 6-year-old brother. What approach should the PMHNP take when
interviewing this child? - Answers -Provide toys and allow the child to play
Which eating disorder is considered ego syntonic? - Answers -Anorexia Nervosa
(Anorexia Nervosa is challenging to treat because it is ego syntonic. In other words,
one's behaviors, feelings and values are in line with the needs of the ego and reliable to
one's self image.)
A 30-year-old G1P0,1 has become increasingly oddly related, neglecting self-care,
sleeping much of the day, eating minimally, crying easily, and despite reassurance that
her pregnancy is progressing normally, worries that she will lose the pregnancy. Which
of the following medications is considered least harmful in pregnancy? - Answers -
Sertraline
A 10-year-old boy who had been prescribed fluoxetine for major depressive disorder
presents to the psychiatric emergency department for running into the street in front of a
car on the way home from school. In the emergency department, he has been
selectively mute, but the nurse practitioner student was able to elicit his desire to be
dead. He has been medically cleared pending a psychiatric evaluation. What is the most
common sign of major depressive disorder in children? - Answers -Psychomotor
agitation
A 6-year-old boy is referred by the child study team for speech difficulty. On
examination the boy is friendly and cooperative, his speech is clear, and he uses simple
sentences with a limited vocabulary. Most notably he confuses verb tenses consistently.
The parents report he met most of his developmental milestones except speech, which
was delayed. His clinical presentation is most consistent with which of the following? -
Answers -Expressive language disorder
The school psychologist refers a 7-year-old girl with difficulty reading, distractibility, and
writing avoidance behaviors. The child has no diagnosed conditions, takes no
medications, and met all of her developmental milestones. She loves arts and crafts and
physical education. Prior to diagnosing a learning disorder, which of the following
screening tests must be performed? - Answers -Vision and hearing
Which disorder is associated with higher rates of ADHD, enlarges testes, a long narrow
face, hypotonia and short stature? - Answers -Fragile X (Fragile X is associated with a
higher rate of ADHD, impaired intellectual ability, learning d/o's, autism spectrum d/o.
Physical attributes include hypotonia, flat feet, enlarges testes, long narrow face, flexible
fingers and short stature.)
,A 10-year-old girl is referred for evaluation of behavioral difficulties. Her teachers report
that she is easily distracted and fails to complete any class work, and often stares off
into space or tries to chat with her neighbor. Her mother reports that mornings are the
most difficult because of her general disorganization and forgetfulness. Otherwise she is
socially engaged and enjoys many activities. Which of the following is the most likely
diagnosis? - Answers -Attention deficit disorder
An 8-year-old boy presents with nocturnal enuresis, which persists despite behavioral
interventions including eliminating fluid intake in the evening, scheduled awakening at
night to use the bathroom, and a urine alarm. Which of the following medications is
most appropriate? - Answers -Imipramine
Sam is 11 years old without past psychiatric history. He was born by normal
spontaneous vaginal delivery with normal APGAR scores. He has met all of his
developmental milestones. He began sixth grade this year and has had increased
trouble falling asleep. He has always had bedtime rituals but lately they are extending in
complexity and length. Most of his time in the evening is spent checking that the lights
are turned off and that the windows are locked. As a result, he is only getting 5 hours of
sleep at night and now has excessive daytime sleepiness with decreased interest in
socialization and failing grades. Which of the following infectious diseases may
contribute to this clinical presentation? - Answers -Streptococcus
The PMHNP is providing psychoeducation and anticipatory guidance to the concerned
parent regarding night terrors. At which stage of sleep is this most likely to occur? -
Answers -Stage 3 to 4
Early onset Schizophrenia is considered what? - Answers -All of the statements listed
are true. (Early onset schizophrenia is rare. It is 8X more prevalent amongst 1st degree
relatives (Sadock, Sadock & Ruiz, 2014).
Child protective services is requested for an evaluation of a 9-month-old girl in foster
care whose mother was on a methadone maintenance program and using cocaine while
pregnant. The child is HIV negative and during the assessment you learn of a 3-year-old
brother who is HIV positive. You are asked to recommend placement for both these
children. Which of the following is best? - Answers -A foster home
A 6-year-old boy is referred by the child study team for speech difficulty. On
examination the boy is friendly and cooperative, his speech is clear, and he uses simple
sentences with a limited vocabulary. Most notably he confuses verb tenses consistently.
The parents report he met most of his developmental milestones except speech, which
was delayed. His clinical presentation is most consistent with which of the following? -
Answers -Expressive language disorder
In regards to Insecure Attachment: Ambivalent type children are more likely to
________________. - Answers -Be bullied (Insecure attachment: Ambivalent children
are uncertain of a caregiver's response regardless of a situation. These children are
,more likely to be bullied and do worse with separations. The caregiver sometimes uses
threats of abandonment as a form of punishment.)
An 8-year-old boy is referred to you for evaluation for disruptive behavior in school. The
teachers report that without warning the boy will make disruptive sounds or shout out in
class. Other than these instances the boy is described as polite and well kempt, but
restless. This clinical presentation is most consistent with which of the following
disorders? - Answers -Tourette's syndrome
Ella is trying to help her 3-year-old son sleep through the night but reports recently he
has had three episodes of waking up within 3 hours of falling asleep with inconsolable
screaming and crying. He then falls back asleep on his own and has no memory of what
happened. What would be the best intervention? - Answers -Create and maintain
bedtime routine and reduce stimuli
A pregnant woman with depression is reluctant to take medication for fear of causing
her baby neonatal abstinence syndrome due to selective serotonin reuptake inhibitor
(SSRI) medication. Her husband states they would like to use a faith healer instead.
Which of the following is most accurate regarding the prognosis of depression during
pregnancy? - Answers -The actual course of depression cannot be predicted
Which of the following statements regarding intellectual developmental disorder is
false? - Answers -IQ test scores remain the gold standard for determining intellectual
disability (IQ test scores are not the gold standard for determining intellectual disability.
Furthermore, IQ tests fail to asses reasoning in real life scenarios and fail to measure
mastery of practical tasks despite measuring conceptual capacity.)
A father brings his 6-year-old son to you because he is worried about him. He states
that the son sits up in bed shortly after falling asleep and screams. He says he is
inconsolable and unable to be awakened during these episodes but eventually he falls
back asleep. The father states he is not able to fall back asleep after those episodes
and is exhausted and falling asleep at work during the day. The child is energetic and
playful during the day and has no memory of the episodes. What is the most
appropriate response? - Answers -"I can see this is upsetting for you."
The certified nurse midwife is evaluating a 29-year-old woman 2 weeks postpartum and
finds her neglecting her self-care and minimally attentive to the baby and will not allow
anyone else to care for the baby. During the visit a PMHNP is able to provide webcam
consultation and liaison services. Based on the information provided, what is the priority
in the management of this patient? - Answers -Admit the patient to the hospital
Which of the following is a potential risk factor for Anorexia Nervosa? - Answers -All of
the statements listed are potential risk factors. (A gay male orientation, Ballet school, &
a male on a high school wrestling team
, A mother 4 months postpartum is referred to infant psychiatry as the baby has failed to
gain weight over the last 2 months. He has dropped from the 75th percentile to the 50th
percentile. The mother states that up until 8 weeks of age he was gaining weight and
growing just fine. The baby is generally happy and continues to meet his developmental
milestones. Of note, the mother has returned to work after her postpartum leave 2
months ago and the baby is in daycare 5 days a week. The mother notes that he has
been increasingly spitting up for the last month soon after receiving breast milk via the
bottle. She has also started to supplement with formula out of concern for his poor
weight gain. This clinical description is most consistent with which type of disorder? -
Answers -Rumination disorder
Which of the following statements regarding intellectual developmental disorder is
false? - Answers -Mild - moderate intellectual disability may not be apparent until
adulthood (Moderate intellectual disability may not be apparent until adulthood is false.
Academic learning difficulty would be apparent in school age children with a mild level
of disability and markedly apparent in those with moderate disability.)
In terms of the management of Bipolar disorder in pregnancy, one should avoid Lithium,
Valproic acid and Carbamazepine, especially in which trimester? - Answers -First
(Lithium, Valproic acid and Carbamazepine have been associated with fetal harm, with
the greatest risk occurring in the first trimester)
An 8-year-old boy diagnosed with leukemia is referred to child psychiatry because he is
consistently displaying a flat affect, irritability, angry acting out, and occasional physical
aggression toward his 6-year-old brother. What approach should the PMHNP take when
interviewing this child? - Answers -Provide toys and allow the child to play
A pregnant woman with depression is reluctant to take medication for fear of causing
her baby neonatal abstinence syndrome due to selective serotonin reuptake inhibitor
(SSRI) medication. Her husband states they would like to use a faith healer instead.
Which of the following is most accurate regarding the prognosis of depression during
pregnancy? - Answers -The actual course of depression cannot be predicted
A 32-year-old woman who is 6-months postpartum requests a psychiatric house call
while her husband is at work. Upon entering the home, the PMHNP notices a well-cared
for infant playing in a crib, and the patient sitting in her breakfast nook overlooking the
nearby park. She is requesting a medication to help her relax because she feels as if
she is walking on eggshells around her husband for fear of him "getting physical with
me" if the baby cries too much. Which of the following best describes this woman's
circumstance? - Answers -Tension building phase
Which of the following statements regarding Autism Spectrum Disorder is false? -
Answers -Asperger's disorder is a separate diagnosis from Autsim Spectrum Disorder in
the DSM-5. (Autism spectrum disorder encompasses the disorder previously referred to
as Asperger's disorder. Previously, Asperger's disorder was used to describe symptoms
